PURPOSE: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. METHODS: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. RESULTS: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. CONCLUSIONS: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Cambridge Centre for Artificial Intelligence in Medicine University of Cambridge Cambridge UK

Cancer Research UK Cambridge Institute Cambridge UK

Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology OUH Odense University Hospital Odense Denmark

CHRC CEDOC NOVA Medical School New University of Lisbon Lisbon Portugal

Department Neuroscience Neurointensive Care ASST Monza Monza Italy

Department of Anaesthesia and Intensive Care 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India

Department of Anesthesia Intensive Care and Emergency Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Anesthesiology and Operative Intensive Care Medicine Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt Universität zu Berlin and Berlin Institute of Health Berlin Germany

Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele 20072 Milan Italy

Department of Critical Care King's College Hospital London UK

Department of Critical Care King's College London Guy's and St Thomas' Hospital London UK

Department of Critical Care Royal Surrey Hospital and Faculty of Experimental Medicine University of Surrey Guildford UK

Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium

Department of Intensive Care Medicine Laboratory of Critical Care Computational Intelligence Amsterdam UMC Vrije Universiteit Amsterdam The Netherlands

Department of Intensive Care Medicine Research VUmc Intensive Care UMC Location VUmc VU Amsterdam Amsterdam The Netherlands

Department of Intensive Care Medicine University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Internal Medicine and Pediatrics Faculty of Medicine and Health Sciences Ghent University Ghent Belgium

Department of Pathophysiology and Transplantation University of Milan Milan Italy

Dipartimento di Scienze dell'Emergenza Anestesiologiche e della Rianimazione Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Division of Anaesthesia Department of Medicine University of Cambridge Cambridge UK

Division of Anaesthesia University of Cambridge Department of Medicine Cambridge UK

Division of Immunology Department of Pathology University of Cambridge Cambridge UK

Faculty of Medicine Hebrew University Jerusalem Israel

FNKV University Hospital Prague Prague Czech Republic

General Intensive Care Unit of the Shaare Zedek Medical Center Jerusalem Israel

Hedenstierna Laboratory Department of Surgical Science Uppsala University Uppsala Sweden

Intensive Care Unit AnOpIVA Akademiska sjukhuset Uppsala Sweden

Intensive Care Unit Hospital General Universitario de Castellón Castellón de la Plana Spain

Intensive Care Unit Hospital Universitario de Torrejón Madrid Spain

IRCCS Humanitas Research Hospital Via Manzoni 56 Rozzano 20089 Milan Italy

Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore Rome Italy

JVF Intensive Care Unit Addenbrookes Hospital Cambridge UK

Médecine Intensive et Réanimation APHP Saint Louis Hospital Paris University Paris France

Neurosciences and Trauma Critical Care Unit Anaesthesia Medical Examiner and Clinical Lead Organ Donation Cambridge University Hospitals NHS Foundation Trust Cambridge UK

Neurosciences and Trauma Critical Care Unit Cambridge University Hospitals Cambridge UK

Pirogov National Medical and Surgical Center Moscow 105203 Russian Federation

Polyvalent Intensive Care Unit Hospital de São Francisco Xavier CHLO Lisbon Portugal

School of Medicine and Surgery University of Milano Bicocca Milan Italy

School of Medicine Klinikum rechts der Isar Department of Anesthesiology and Intensive Care Technical University of Munich Munich Germany

School of Sports and Health Sciences University of Brighton Brighton UK

Service de Médecine Intensive Réanimation Hôpital Bicêtre AP HP Université Paris Saclay Inserm UMR S_999 Le Kremlin Bicêtre France

Universidad Francisco de Vitoria Madrid Spain

Université de Paris Paris France

University of Cambridge Division of Anaesthesia Addenbrooke's Hospital Hills Road Cambridge UK

Intensive Care Med. 2022 Aug;48(8):1130-1131. doi: 10.1007/s00134-022-06801-2. PubMed

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